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Compartment Syndrome and Shin Splints

Hi Stew - I am now suffering from shin splints every time I run.  It does not matter if I lay off running for a period of time or if I start out running shorter distances.  What can I do to get myself back in to long distance running?

If the typical treatment of shins splints does not work for you, it is time to see a doctor. 

Usually the following will help treat your symptoms:

- some time off from running (1-2 weeks),

- new running shoes,

- proper stretch / flex of shins prior to and after running,

- a week of over-the-counter anti-inflammatory medication and/ or ice

- myofascial release - see link

- physical therapy

However, if doing the above and going to (the Running Doctor website) does not help you.  It is time to see a doctor in person.  It could be a something different, but fairly common in runners of all ages.  Typically, in the military and law enforcement training running programs people do too much / too soon / too fast.  Sometimes people preparing for a fitness test will forego the proper amount of time to build a foundation and the extreme increase in activity level will cause Compartment Syndrome.

Chronic compartment syndrome results from repetitive trauma and overuse. The following are possible causes:

                Running - especially on hard surfaces in boots / poor shoe inserts

                Repetitive stress from running, rucking, impact to shin area

Some of the symptoms of Compartment Syndrome are swelling in the lower legs, pain, numbness and can result in permanent nerve damage.

Here is the reader's digest version of the symptoms / treatment from another reader who had Compartment Syndrome and thought he had shins splints:

I had pain in the lower legs when running.  It only induced if I ran faster than a 9 min/mile, and the onset of the pain was directly proportional to how much faster than 9 min/mile I ran.

If I kept running after the onset of the pain, (ie., tried to run through it), the muscles would seize and I'd be unable to flex my foot...creates a "slapping" sound when the foot strikes the ground.  This is a big indicator that it is NOT shins splints.

The seized muscles would release and the acute pain / swelling would cease within an hour after I finished running. (If I'd had shin splints before, I'd have known that shin splint pain doesn't just go away).  The residual pain would go away within 24 hours; thus I was running every other day.

Compartment Syndrome is basically the fascia surrounding the muscles in question no longer expands to allow the muscle to expand during
exercise.  With nowhere to expand, the blood flooding the exercised muscle puts pressure on the blood vessels and nerves causing the
above symptoms.

After being diagnosed, I asked the doctor, "what if I just run 9 min/miles for the rest of my life?"  The doc said that the symptoms would induce at a slower and slower threshold and eventually it WOULD NOT RELEASE and I could lose portions of the muscle or the lower leg.  He then instructed me to STOP RUNNING until after surgery.

There's no known reason for ECS, (I thought it might be a function of my age, 45 but my surgeon does work with the Ohio State football team and says that he does about 3 surgeries on Buckeye football players every year and their late teens/early 20's).  The test for CS was actually more
painful than the surgery.  The surgery was fairly simple, they slit my lower legs and cut the fascia around the lower compartments then went under the skin and cut the fascia around the upper compartments.  

That is why when people ask about running through the pain and sucking up shin splints, it is always best to think before you run again.  It could be something an easy warm up stretch will help, but then again it could be something that requires time and healing or even surgery.  If you are having some of the CS symptoms above, you should consider not running and seeing a doctor.

BUT there is more than one way to treat ECS - how about Physical Therapy with NO SURGERY - here is an addition from another reader:

While surgery is a viable option, it's important to note that it is not as reliable as one believes. First of all, it only has a 80% success rate at best. Then one also has to deal with the long recovery time. While it isn't a major surgery, the recovery takes a long time before one can run again.

How about physical therapy?  It takes time, but it is a realistic approach toward treating CS. I personally had CS with pressures up into the 60s (standard is below 25) and I couldn't run for a any pace. Over a month of careful stretching and soft tissue work I can now ace the PFA and I'm preparing for the PAST in a few months. I make it a priority to stretch everyday and use a foam roller to massage my shins, calves, hamstrings, and quads to prevent any other types of injuries.

I just don't want people who are able to run think that a surgery with a long post-op is the only option with CS. I couldn't run for 3 years because of my CS and now I can run until I puke.

Thanks for the emails - as you can see if you cannot run - stop running - see a doctor - and realize you always have options to surgery.

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Stew Smith is a former Navy SEAL and fitness author certified as a Strength and Conditioning Specialist (CSCS) with the National Strength and Conditioning Association. If you are interested in starting a workout program to create a healthy lifestyle - check out the Fitness eBook store and the
Stew Smith article archive at To contact Stew with your comments and questions, e-mail him at

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